Sunday, May 20, 2012

That Transgender 5-Year-Old

The band played a gig down in Southern Maryland last night, at Solomons Island; the crowd liked us and we had a great time. My wife and I stayed overnight and had a leisurely drive back today, checking out the beaches and scenery along the way.

When we got home this afternoon the Washington Post was in the driveway, and wow ... the big story on Page One is "TRANSGENDER AT FIVE," yes, all in caps, with a picture of a kid getting a haircut, looking at the camera. The story takes up approximately two thirds of the real estate on the front page.

As I carried the paper up to the house, I checked out the subhead: "She first declared she was a boy when she was 2 years old. Her parents brushed it off but slowly concluded this wasn't just a phase."

That secondary headline had three "she's" in the first sentence about a transgender boy.

Jumping through this long article (which you should read in its entirety):

Jean [the mother] tried to put her daughter’s behavior to rest. She sat down with a toddler-version of an anatomy book and showed Kathryn, by then 3, the cartoonish drawings of a naked boy and girl.

“See? You’re a girl. You have girl parts,” Jean told her big-eyed daughter. “You’ve always been a girl.”

Kathryn looked up at her mom, incomprehension clouding her round face.

Pretty good question. If this is what boys are supposed to look like, then this little guy is wondering what happened to make him look like a girl.

She went back online and watched videos of parents talking about their realization that their child was transgender. They all described a variation of the conversation she’d had with Kathryn: “Why did you change me?” “God made a mistake with me.” “Something went wrong when I was in your belly.”

Many talked about their painful decision to allow their children to publicly transition to the opposite gender — a much tougher process for boys who wanted to be girls.

Some of what Jean heard was reassuring: Parents who took the plunge said their children’s behavior problems largely disappeared, schoolwork improved, happy kid smiles returned.

But some of what she heard was scary: children taking puberty blockers in elementary school and teens embarking on hormone therapy before they’d even finished high school.

All of it is a new and controversial phenomenon.

In the United States, children have been openly transitioning genders for probably less than a decade, said Jack Drescher, a New York psychiatrist who is a leader in the field of gender orientation. There is very little to go on, scientifically, to support that approach, and the very idea of labeling young children as transgender is shocking to many people.

But to others, it makes perfect sense.

There is something scary in the idea of giving children hormones before they reach puberty. You might be making a wrong decision, the child may have matured and become comfortable with the sex that was assigned at birth, after all. On the other hand, transition is very much more difficult after the body has acquired the sex characteristics of an adult. The woman with a deep voice and broad shoulders, the man with a narrow waist and breasts, may very well wish that responsible adults had at least delayed those changes until they had become adults and were responsible to make such a decision.

To make my view clear: I am not saying it is right or it is wrong to administer hormones or postpone puberty in young transgender people. It is a difficult decision and one that will require a lot of judgments to be made, and a lot of assumptions about what the future will bring if the young person goes down one fork in the road or the other, and the factors are different in every unique case. Either choice will require unwavering love and trust from the family.

“In children, gender solidifies at about 3 to 6,” explained Patrick Kelly, a psychiatrist with the division of child and adolescent psychiatry at Johns Hopkins Children’s Center.

That’s about the age when girls gravitate to girl things and boys to boy things. It’s when the parents who ban baby dolls or toy guns see their little girl swaddle and cradle a stuffed animal or watch in awe as their boy makes guttural, spitting Mack truck sounds while four-wheeling his toast over his eggs, then uses his string cheese as a sword.

And it’s the age when a child whose gender orientation is at odds with his or her biology begins expressing that disconnect — in Kathryn’s case, loudly.

The American Psychiatric Association has an official diagnosis for this: gender identity disorder in children.

Those who have it, according to the association’s Diagnostic and Statistical Manual of Mental Disorders, experience “a persistent and intense distress about assigned sex, together with a desire to be (or insistence that one is) of the other sex. There is a persistent preoccupation with the dress and activities of the opposite sex and repudiation of the individual’s own sex.”

And, it adds, “mere tomboyishness in girls or girlish behavior in boys is not sufficient” to warrant the diagnosis. It requires “a profound disturbance of the normal gender identity.”

The manual is being updated this year, and a task force that Drescher sits on is studying whether to remove the word “disorder” from the diagnosis and instead call the condition “gender incongruence.”

One of my kids had a friend in kindergarten and first grade who was a girl but dressed and acted like a boy -- this was not a transgender kid, she was definitely a girl but boyish. In fact, my kid thought she was a boy, and seemed kind of confused when told she was a girl. And then there was a shrug and it was time to go back outside and play. Because, really, why does it matter at that age?

I am skipping though the article, but Kathryn has changed her name and is going to school now as Tyler, a boy. The article discusses some of the issues that came up, you will find it interesting but I am not going to quote it all here.

Tyler doesn’t really like to talk about Kathryn or even acknowledge she existed.

“I’m not transgender,” he fumes when he hears the word, often spoken by his mom as she explains things. “I. Am. A. Boy.”

During one of my visits a few months ago, he showed me their family picture wall, full of pictures of two girls in lovely dresses.

“No Tyler,” he pouted.

Those are issues that are easy for Tyler’s parents to fix.

But in about five years, they will have to decide whether to put Tyler on puberty blockers to keep his body from maturing and menstruating. Using those drugs represents a leap of faith, psychiatrists said, though the effects are reversible if the puberty blockers are halted.

The much tougher call comes when kids are about 15 or 16. At that age, they can begin hormone injections that will make them grow the characteristics of the opposite biological sex.

That’s a method being pioneered by Norman Spack, the director of one of the nation’s first gender identity medical clinics at Children’s Hospital Boston and an advocate of early gender transitions. Those hormone treatments essentially create a nearly gender-neutral being, making sex-change surgery far less painful and expensive for young adults. But the hormones also make people infertile — a daunting and irreversible decision for parents to make when a child is 15 or 16. Only a handful have opted to do so, Spack said.

Jean e-mailed me an article about the drug controversy late one night, the time that many parents stay up and fret about their kids. “See what we’re facing?!” she wrote.

She acknowledges anxieties about what lies ahead. But Jean and Stephen aren’t harboring doubts about what they are doing now.

“If Tyler wants to be Kathryn again, that’s fine,” she said. “But right now, this works. He’s happy. I just want my child to be happy.”

As for Tyler, he is reveling in his new identity. The constant nagging, fighting, obsessing about being a boy is gone. Tyler is just Tyler, a high-energy kid with a Spider-Man-themed bedroom.

On my last visit, he took a brief break from playing with my boys and their endless supply of space cruisers to show me a new addition to the family picture wall. It now features a prominent photo of Tyler in short hair and a red polo shirt. He is smiling.

There are two interesting things about this article, to me. The first is, as I mentioned above, the awkward and insulting misuse of pronouns. Tyler and his family and his friends agree he is a boy, so why is the Washington Post saying "she" did this and "she" did that? They are editorially stating that Tyler and the rest of them are wrong and that Tyler is "really" a girl, as if some journalist knows better.

The second interesting thing is the fact that The Post published this article at all, and so prominently displayed. I am seeing this as political mischief; now that President Obama has made a statement about marriage equality and nominee-to-be Romney has come out on the other side, we can expect increased polarization along political lines regarding intensely personal issues such as who Americans can marry and what gender they should be.

But this is a more complicated and sensitive issue than marriage, I think. I expect it will be difficult for some liberals to adjust to ideas about transgender children, ideas of postponing puberty and administering hormones, it will be a kind of test of faith for them. If you believe in live-and-let-live then you will grant a blessing to the young person who has the courage to follow the path that destiny has laid out for them, and you will trust families to make the difficult decisions that directly affect their lives.

Jim said "To make my view clear: I am not saying it is right or it is wrong to administer hormones or postpone puberty in young transgender people. It is a difficult decision and one that will require a lot of judgments to be made...".

No, its not a difficult decision. If a pre-pubescent child wants to be a gender different than his or her birth gender there is no uncertainty as to what should be done - he or she should be given hormone blockers and when he or she is 18 he or she can decide whether or not to take the desired gender's hormones. The hormone blockers are reversable and if the child should change his or her mind no harm done, whereas if a child is transgendered and you let the undesired gender's hormones burn in secondary sexual characteristics that are not wanted the damage is to a significant degree irreversable.